How to amputate limbs without fainting: the trials of a Victorian surgeon

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Joseph Townend was born into an impoverished Methodist family in Yorkshire in 1806. When he was a young child, he attempted to lift a kettle from its “reekon” (the pot-hook) when his apron caught fire. He remembered “being laid upon the floor” and having his wounds “saturated with treacle, in order to extract the fire”. His burns were extensive and, when they healed, his right arm was fused to his side. Years later, when he was working in a cotton mill, he decided to go to the Manchester Infirmary to have his arm separated.

Once at the hospital, a male attendant wound a thick bandage over his eyes, then led him up an alley to the operating theatre, which was packed with medical students. A surgeon gruffly warned: “Now, young man, I tell you, if when you feel the knife you should jerk, or even stir – you will do it at the hazard of your life.” Anaesthetics such as chloroform would not be invented for another 23 years and no analgesic (such as whiskey or laudanum) was offered. All Townend could hope for was a well-sharpened knife and the surgeon’s experienced hands.

Anatomy of the armpit by Claude Bernard and Charles Huette, 1848Credit:
Wellcome Collection

“All was still,” Townend recalled, when he felt the surgeon grasp his arm and “with a forcible thrust, through went the knife, as near the pit of the arm as possible… the progress of the instrument I distinctly heard.” The pain was “most exquisite”. As the “smoking wound” was being dressed and bound, Townend reflected on the purpose of pain in bringing him closer to God. He spent the following weeks in hospital “weeping”, singing hymns and reading the scriptures to other patients. After leaving hospital, he dedicated his life to Christ and became a Methodist missionary in Australia.

Townend’s experience of pain was not unusual. Richard Barnett’s new book, Crucial Interventions, brings this world of 19th-century surgery to life. He has structured his book according to bodily parts – head; eyes; ear, nose and throat; hands and arms; chest; abdomen; genitals; legs and feet. These themes are interspersed with short, elegant essays tracing the history of anaesthesia, antisepsis, asepsis, nursing, war surgery, medical education and organisation. At the end, Barnett speculates on the experience of patients like Townend.

The musculature of the hand by Claude Bernard and Charles Huette, 1848Credit:
Wellcome Collection

It is not a book for the faint-hearted. There are hundreds of beautifully drawn, but gruesome illustrations from the 19th century. Barnett reproduces intricate sketches on how to wield knives when cutting into human flesh. He shows us a vast range of surgical instruments – not only knives but also saws, scissors, probes, forceps, needles, clamps, ligatures and so on. I found myself refusing to imagine them entering the vulnerable bodies of desperately ill and wounded men and women.

If there is one theme that dominates Barnett’s evocative book it is the vast transformations that took place in surgical practices and technologies during the 19th century. Before 1846, surgeons conducted their work without the help of effective anaesthetics such as ether or chloroform. They were required to be “men of iron… and indomitable nerve” who could ignore the screams of their patients.

Surgery for cancer of the tongue by Pancoast, 1846Credit:
Wellcome Collection

Many apprentice-surgeons found themselves incapable of maintaining the necessary emotional distance. For example, Silas Weir Mitchell went on to become one of the most influential American physicians of the 19th and early 20th centuries. As a young doctor, however, he had hoped to become a surgeon. Anaesthetics had not been invented when he started training, so he was forced to amputate limbs on patients who were fully conscious of every cut of his knife. When operating on one woman who was being held down by strong men, he remembered the “terribleness… the screams, the flying blood jets – and the struggle”. He couldn’t continue. Surgery was “horrible to me”, he later recalled, admitting that he “fainted so often at operations that I begun to despair”. In the end, Mitchell was forced to concede that he “had neither the nerve nor the hand which was needed in those days for those operations”.

The best surgeons were those – like the great Sir Robert Liston – who could amputate a limb in minutes. Surgeons, as well as their patients, needed courage and determination. Was it any wonder that some critics accused them of sadism? A few years after the introduction of chloroform, one critic even claimed that some surgeons had acquired a “taste for screams and groans”: might they be unable to “proceed agreeably in their operations without such a musical accompaniment”, he sneered.

It would be a mistake to see chloroform as the only innovation of the 19th century. Indeed, it is possible to argue that the introduction of antiseptic and aseptic techniques saved many more lives. Barnett points out that in the early decades of the 19th century, even major operations often took place in private homes. Surgeons wore street clothes; the environment was noisy, dirty and bloody. Mortality was high.

By the end of the century, the transformation was remarkable. Barnett argues that surgeons increasingly saw themselves as elite scientists. Operations took place in aseptic environments, with physicians and nurses wearing sterile white gowns. The “theatre” element of operations was over: spectators were no longer allowed to crowd around the table. Instead, bodies were cut open and stitched back together in silence. Even pauper patients like Townend would be mercifully put to sleep before the knife-wielding surgeon appeared.

Joanna Bourke is the author of The Story of Pain: From Prayer to Painkillers (OUP)